Abstract 14918: Blood Product Transfusion and Postoperative Bleeding Can Be Predicted by Platelet Function Analysis PFA-100® in Children Undergoing Cardiac Surgery
Introduction: Excessive bleeding can be a problem during or after cardiac surgery. Cardiopulmonary bypass associated platelet dysfunction is an important determinant of coagulopathy. The PFA-100® tests measures platelet dysfunction by simulating high shear in the presence of a platelet agonist. The time taken to form a platelet plug is known as closure time (CT) and is measured in seconds. We aimed to determine the relationship of PFA-100® CT and the amount of perioperative bleeding and blood products given in children undergoing cardiac surgery.
Methods: A total of 347 children undergoing surgery with cardiopulmonary bypass between 2008 and 2012 were included. The volume of red blood cells (RBC) and fresh frozen plasma (FFP) transfused together with chest tube drainage postoperatively were indexed to weight. Trends between PFA-100® CT, transfusion requirements and post-operative bleeding were analyzed using parametric analysis and logistic regression.
Results: Patients with prolonged CT had greater volumes of RBC and FFP transfused (35.4 ± 3.8 ml/kg, mean ± 1 S.E. and 23.6 ± 2.4 ml/kg respectively) than patients with normal CT (21 ± 3.2 ml/kg and 12 ± 2.2 ml/kg respectively, P<0.001). CT significantly correlated with chest tube drainage postoperatively (P < 0.03). Analysis of covariance found that cardiopulmonary bypass time, number of ventricles, and PFA-100® CT were all significant independent correlates of product volume transfused. Logistic regression showed that patients with a prolonged CT were 88% more likely to be transfused with platelets (OR= 1.88, 95% CI: 1.18-3.021, P< 0.0081). Similarly patients with a prolonged CT were 90% more likely to be transfused with cryoprecipitate (OR= 1.90, 95% CI: 1.00-3.62, p=0.05).
Conclusion: In conclusion, an abnormally prolonged preoperative PFA-100® CT is associated with increased RBC and FFP requirements and greater volume of chest tube drainage perioperatively. Attention should be given to the preoperative PFA-100® CT test in pediatric patients as it appears to detect platelet dysfunction and may subsequently informs about amount of blood loss expected and of transfusion products needed.
- © 2013 by American Heart Association, Inc.